Discrimination of Alzheimer's disease and mild cognitive impairment by equivalent EEG sources: a cross-sectional and longitudinal study

EEG filtering based on blind source separation (BSS) for early detection of Alzheimer's disease

OBJECTIVE

Development of an EEG preprocessing technique for improvement of detection of Alzheimer's disease (AD). The technique is based on filtering of EEG data using blind source separation (BSS) and projection of components which are possibly sensitive to cortical neuronal impairment found in early stages of AD.

METHODS

Artifact-free 20s intervals of raw resting EEG recordings from 22 patients with Mild Cognitive Impairment (MCI) who later proceeded to AD and 38 age-matched normal controls were decomposed into spatio-temporally decorrelated components using BSS algorithm 'AMUSE'. Filtered EEG was obtained by back projection of components with the highest linear predictability. Relative power of filtered data in delta, theta, alpha 1, alpha 2, beta 1, and beta 2 bands were processed with Linear Discriminant Analysis (LDA).

RESULTS

Preprocessing improved the percentage of correctly classified patients and controls computed with jack-knifing cross-validation from 59 to 73% and from 76 to 84%, correspondingly.

CONCLUSIONS

The proposed approach can significantly improve the sensitivity and specificity of EEG based diagnosis.

SIGNIFICANCE

Filtering based on BSS can improve the performance of the existing EEG approaches to early diagnosis of Alzheimer's disease. It may also have potential for improvement of EEG classification in other clinical areas or fundamental research. The developed method is quite general and flexible, allowing for various extensions and improvements.

Alpha rhythms in mild dements during visual delayed choice reaction time tasks: A MEG study

Can simple delayed response tasks affect latency and amplitude of magnetoencephalographic midline alpha rhythms (6-12 Hz) in early dementia? We recruited 15 mild Alzheimer's disease (AD) and 10 vascular dementia (VaD) patients (paired mini mental state exam of 17-24). The control groups comprised 18 young and 22 elderly normal subjects. In the first task, a simple "cue" stimulus (one bit) was memorized along a brief delay period (3.5-5.5s) up to a "go" stimulus triggering (right or left) button press. In the second task, the "cue" stimulus remained available along the delay period. Event-related reduction in power of the alpha rhythms indexed the cortical activation (event-related desynchronization, ERD) for the trials associated with correct behavioral responses. Behavioral performances to both tasks were lower in the AD and VaD patients than in the normal subjects. In particular, just four AD and five VaD patients executed a sufficient amount of correct responses for the alpha ERD analysis, so they were included in a unique group. In both tasks, the alpha ERD peak was later in latency in the demented and normal elderly subjects than in the normal young subjects. Furthermore, the alpha ERD peak was stronger in amplitude in the demented patients than in the normal subjects. These results suggest that simple delayed response tasks during physiological recordings are quite difficult for patients even at an early dementia stage. Such difficulty may induce the abnormal amount of the related cortical activation in dementia as revealed by the alpha ERD.

Electroencephalogram in the dementia workup

Dementia is affecting an increasing proportion of the population in the developed world. It is important to reach a correct diagnosis of dementia, because this has implications on the treatment. The electroencephalogram (EEG) is, in general, not a sensitive test for detecting dementia and is not recommended in the standard workup of dementia. In spite of this, however, EEG is useful in patients with deteriorating mental status in whom dementia is suspected mainly to rule out delirium, depression, atypical complex partial seizures, and prion disease. An EEG also provides insight into the physiology of different dementia types. The EEG is most useful when interpreted within a well-defined clinical context, such as knowing the patient's degree of cognitive impairment. It is a noninvasive and inexpensive test, and the threshold should be low for ordering it. This article summarizes EEG findings with aging, different dementia types, and conditions masked as dementia.

EEG source imaging

OBJECTIVE

Electroencephalography (EEG) is an important tool for studying the temporal dynamics of the human brain's large-scale neuronal circuits. However, most EEG applications fail to capitalize on all of the data's available information, particularly that concerning the location of active sources in the brain. Localizing the sources of a given scalp measurement is only achieved by solving the so-called inverse problem. By introducing reasonable a priori constraints, the inverse problem can be solved and the most probable sources in the brain at every moment in time can be accurately localized.

METHODS AND RESULTS

Here, we review the different EEG source localization procedures applied during the last two decades. Additionally, we detail the importance of those procedures preceding and following source estimation that are intimately linked to a successful, reliable result. We discuss (1) the number and positioning of electrodes, (2) the varieties of inverse solution models and algorithms, (3) the integration of EEG source estimations with MRI data, (4) the integration of time and frequency in source imaging, and (5) the statistical analysis of inverse solution results.

CONCLUSIONS AND SIGNIFICANCE

We show that modern EEG source imaging simultaneously details the temporal and spatial dimensions of brain activity, making it an important and affordable tool to study the properties of cerebral, neural networks in cognitive and clinical neurosciences.

EEG dynamics in patients with Alzheimer's disease

Alzheimer's disease (AD) is the most common neurodegenerative disorder characterized by cognitive and intellectual deficits and behavior disturbance. The electroencephalogram (EEG) has been used as a tool for diagnosing AD for several decades. The hallmark of EEG abnormalities in AD patients is a shift of the power spectrum to lower frequencies and a decrease in coherence of fast rhythms. These abnormalities are thought to be associated with functional disconnections among cortical areas resulting from death of cortical neurons, axonal pathology, cholinergic deficits, etc. This article reviews main findings of EEG abnormalities in AD patients obtained from conventional spectral analysis and nonlinear dynamical methods. In particular, nonlinear alterations in the EEG of AD patients, i.e. a decreased complexity of EEG patterns and reduced information transmission among cortical areas, and their clinical implications are discussed. For future studies, improvement of the accuracy of differential diagnosis and early detection of AD based on multimodal approaches, longitudinal studies on nonlinear dynamics of the EEG, drug effects on the EEG dynamics, and linear and nonlinear functional connectivity among cortical regions in AD are proposed to be investigated. EEG abnormalities of AD patients are characterized by slowed mean frequency, less complex activity, and reduced coherences among cortical regions. These abnormalities suggest that the EEG has utility as a valuable tool for differential and early diagnosis of AD.

Mapping distributed sources of cortical rhythms in mild Alzheimer's disease. A multicentric EEG study

The study aimed at mapping (i) the distributed electroencephalographic (EEG) sources specific for mild Alzheimer's disease (AD) compared to vascular dementia (VaD) or normal elderly people (Nold) and (ii) the distributed EEG sources sensitive to the mild AD at different stages of severity. Resting EEG (10-20 electrode montage) was recorded from 48 mild AD, 20 VaD, and 38 Nold subjects. Both AD and VaD patients had 24-17 of mini mental state examination (MMSE). EEG rhythms were delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), and beta 2 (20-30 Hz). Cortical EEG sources were modeled by low resolution brain electromagnetic tomography (LORETA). Regarding issue i, there was a decline of central, parietal, temporal, and limbic alpha 1 (low alpha) sources specific for mild AD group with respect to Nold and VaD groups. Furthermore, occipital alpha 1 sources showed a strong decline in mild AD compared to VaD group. Finally, distributed theta sources were largely abnormal in VaD but not in mild AD group. Regarding issue ii, there was a lower power of occipital alpha 1 sources in mild AD subgroup having more severe disease. Compared to previous field studies, this was the first investigation that illustrated the power spectrum profiles at the level of cortical (macroregions) EEG sources in mild AD patients having different severity of the disease with respect to VaD and normal subjects. Future studies should evaluate the clinical usefulness of this approach in early differential diagnosis, disease staging, and therapy monitoring.

Is MCI really just early dementia? A systematic review of conversion studies

OBJECTIVES

Older people commonly present with memory loss although on assessment are not found to have a full dementia complex. Previous studies have suggested however that people with subjective and objective cognitive loss are at higher risk of dementia. We aimed to determine from the literature the rate of conversion from mild cognitive impairment to dementia.

METHODS

Systematic review of MedLine, PsychLit and EmBase.

RESULTS

We identified 19 longitudinal studies published between 1991 and 2001 that addressed conversion of mild cognitive impairment to dementia. Overall the rate of conversion was 10% but with large differences between studies. The single biggest variable accounting for between study heterogeneity was source of subjects, with self-selected clinic attenders having the highest conversion rate. The most important factor accounting for heterogeneity within studies was cognitive testing, with poor performance predicting conversion with a high degree of accuracy.

CONCLUSIONS

These data strongly support the notion that subjective and objective evidence of cognitive decline is not normal and predicts conversion to dementia. The more stringent the measures of both variables the better the prediction of conversion. Mild cognitive impairment, appropriately diagnosed, is a good measure with which to select subjects for disease modification studies.

Genetics of human prefrontal function

Evolution of the prefrontal cortex was an essential precursor to civilization. During the past decade, it became increasingly obvious that human prefrontal function is under substantial genetic control. In particular, heritability studies of frontal lobe-related neuropsychological function, electrophysiology and neuroimaging have greatly improved our insight. Moreover, the first genes that are relevant for prefrontal function such as catechol-O-methyltransferase (COMT) are currently discovered. In this review, we summarize the present knowledge on the genetics of human prefrontal function. For historical reasons, we discuss the genetics of prefrontal function within the broader concept of general cognitive ability (intelligence). Special emphasis is also given to methodological concerns that need to be addressed when conducting research on the genetics of prefrontal function in humans.

Quantitative EEG and dynamic susceptibility contrast MRI in Alzheimer's disease: a correlative study

OBJECTIVE

To investigate the relationship between the electroencephalographic (EEG) power spectra features obtained by quantitative EEG (qEEG) and the hemodynamic parameters detected by dynamic susceptibility contrast-enhanced MR imaging (DSC MRI) in patients with Alzheimer's disease (AD).

METHODS

Fourteen patients with probable AD and 15 elderly healthy controls were included in the study. All subjects underwent both EEG recording in a rest condition and perfusion MRI. Three EEG scalp areas were defined (anterior, central and posterior) and power spectra values were obtained from each scalp area. Relative values of temporoparietal and sensorimotor regional cerebral blood volume (rCBV) were measured bilaterally and successively averaged to obtain a total perfusion index. The brain atrophy index was calculated and used as a covariate to rCBV. Correlation analysis was performed between EEG variables and hemodynamic-morphological parameters.

RESULTS

qEEG power spectra of AD patients were characterized by an increase in mean relative power of theta (4-7.75 Hz) associated with a decrease in alpha (8-12.75 Hz) frequency bands with a topographic distribution over the central and posterior EEG scalp regions, when compared with controls; beta (13-31 Hz) frequency band also displayed a significant decrease over the anterior and posterior EEG scalp regions of AD patients with respect to controls. The DSC MRI revealed a bilateral reduction in the temporoparietal and sensorimotor rCBV with respect to controls. Correlation analysis showed that the total level of hypoperfusion selectively correlates with the EEG power spectra in theta and alpha frequency bands distributed over anterior/central and central region, respectively. Within AD patients, the lower the level of hypoperfusion, the higher the content of EEG power spectra in theta frequency band, and the lower the level of hypoperfusion, the lower the content of EEG power spectra in alpha band.

CONCLUSIONS

The combined qEEG and DSC MRI technology unveiled a selective correlation between neurophysiological and hemodynamical patterns in AD patients. Further investigations will ascertain the relevance of this multi-modal approach in the heterogeneous clinical context of AD.

Voxel- and VOI-based analysis of SPECT CBF in relation to clinical and psychological heterogeneity of mild cognitive impairment

This study aimed to explore the heterogeneity of mild cognitive impairment (MCI) and detect differences in regional cerebral blood flow (rCBF) and cognitive function between progressive mild cognitive impairment (PMCI) and stable mild cognitive impairment (SMCI) in order to identify specific changes useful for early diagnosis of dementia. SPECT was performed in 82 MCI subjects and 20 controls using Tc-99m hexamethylpropyleneamine oxime. Cognitive functions were tested in five domains which included episodic memory, semantic memory, visuospatial function, attention, and general cognitive function. After the initial examination, MCI subjects were clinically followed for an average of 2 years. Twenty-eight subjects progressed to dementia and were defined as PMCI at baseline and 54 subjects remained stable and were defined as SMCI at baseline. The baseline rCBF and cognitive function of PMCI, SMCI, and controls were compared. PMCI had decreased relative rCBF in the parietal lobes and increased relative rCBF in prefrontal cortex compared to SMCI and controls at baseline. The cognitive function of PMCI was more severely impaired compared to SMCI with respect to episodic memory and visuospatial and general cognitive function. Both SPECT and neuropsychological tests had moderate discriminant function between PMCI and SMCI at baseline with the area under the receiver operating characteristic (ROC) curve at 75-77%. The combination of these two methods improved the diagnostic accuracy with the area under the ROC curve at 82-84%. Semantic memory and attention were negatively correlated with left prefrontal relative rCBF among the study population. The results show that the clinical heterogeneity of MCI is reflected in different patterns of psychological and CBF changes. Combined SPECT investigation and neuropsychological testing might predict the future development of dementia in patients with MCI.

A critical discussion of the role of neuroimaging in mild cognitive impairment

OBJECTIVE

In this paper, the current neuroimaging literature is reviewed with regard to characteristic findings in mild cognitive impairment (MCI). Particular attention is drawn to the possible value of neuroimaging modalities in the prediction and early diagnosis of Alzheimer's disease (AD).

METHODS

First, the potential contribution of neuroimaging to an early, preclinical diagnosis of degenerative disorders is discussed at the background of our knowledge about the pathogenesis of AD. Second, relevant neuroimaging studies focusing on MCI are explored and summarized. Neuroimaging studies were found through Medline search and by systematically checking through the bibliographies of relevant articles.

RESULTS

Structural volumetric magnetic resonance imaging (MRI) and positron emission tomography (PET)/single photon emission tomography (SPECT) are currently the most commonly used neuroimaging modalities in studies focusing on MCI. There were considerable variations in demographical and clinical characteristics across studies. However, significant hippocampal and entorhinal cortex volume reductions were consistently found in subjects with MCI as compared with cognitively unimpaired controls. While hippocampal and entorhinal cortex atrophy in subjects with MCI are also well-established risk factors for the development of AD, these measures cannot be regarded as being of high predictive value in an individual case. Evidence for other typical neuroimaging changes in MCI is still scarce. In PET and SPECT studies, reduced blood flow and/or glucose metabolism in temporoparietal association areas, posterior cingulate and hippocampus were associated with a higher risk of progressive cognitive decline in MCI. In quantitative electroencephalogram (QEEG), low beta, high theta, low alpha and slowed mean frequency were associated with development of dementia.

CONCLUSIONS

Existing studies suggest that neuroimaging measures have the potential to become valuable tools in the early diagnosis of AD. To establish their value in routine use, larger studies, preferably with long prospective follow-up are needed.

Theta power in the EEG of alcoholics

BACKGROUND

In this study, the magnitude and spatial distribution of theta power in the resting EEG were examined to explore the changes in the neurophysiological status of the alcoholic brain. Some state- and trait-related issues of theta power increases in the EEG of alcoholics were also examined.

METHODS

Absolute theta (3-7 Hz) power in eyes-closed EEGs of 307 alcohol-dependent subjects and 307 age- and gender-matched unaffected controls were compared by using a repeated-measures ANOVA for the entire region and three subregions (frontal, central, and parietal) separately. Supplementary to the main analysis, the effect of three clinical variables on absolute theta power was examined separately for each gender by using correlation and regression analyses. Gender differences in the theta log power difference between alcoholics and controls were explored by using regional repeated-measures ANOVA.

RESULTS

Increased absolute theta power was seen in alcohol-dependent subjects at all scalp locations. The theta log power increase in male alcoholics was prominent at the central and parietal regions and in female alcoholics at the parietal region when compared with the respective matched controls. Correlation of drinking variables with log theta power exhibited no group-specific differences.

CONCLUSIONS

Increased tonic theta power in the EEG may reflect a deficiency in the information-processing capacity of the central nervous system in alcoholics. The theta power increase may also be an electrophysiological index of the imbalance in the excitation-inhibition homeostasis in the cortex. It is likely that the theta power increase is a trait-related phenomenon and is expressed to differing degrees in the two genders.

Focal temporoparietal slow activity in Alzheimer's disease revealed by magnetoencephalography

BACKGROUND

Patients suffering from Alzheimer's disease exhibit more activity in the conventional electroencephalographic delta and theta bands. This activity concurs with atrophy and reduced metabolic and perfusion rates, particularly in temporoparietal structures.

METHODS

Whole-head magnetoencephalographic recordings were obtained from 15 patients diagnosed with Alzheimer's disease and 19 healthy control subjects during a resting condition. The generators of focal magnetic slow waves were located employing a single moving dipole model.

RESULTS

Dipole density in the delta and theta bands was enhanced in the Alzheimer's disease group compared with healthy control subjects. Slow-wave activity differed significantly between groups in temporoparietal regions of both hemispheres. Right temporoparietal slow-wave activity covaried with cognitive performance, whereas left temporal delta activity varied with a functional status scale.

CONCLUSIONS

Our results support the predominant role of the temporoparietal areas in the diagnosis of Alzheimer's disease. Magnetoencephalography and the source analysis of focal slow activity in particular provide interesting and potentially clinically useful tools to assess functional modifications of patients' brain and to evaluate its relationship with the cognitive status.

Identification of diagnostic evoked response potential segments in Alzheimer's disease

Evoked response potentials (ERPs) to brief flashes of light were analyzed for constituent features that could be used to distinguish individuals with Alzheimer's disease (AD, n = 15) from matched control subjects (n = 17). Statistical k nearest-neighbor methods distinguished AD from control with a maximum sensitivity of 29% and false alarm rate of 12%. The comparable sensitivity/false-alarm values for a statistical projection pursuit method and an extended projection pursuit method, which selectively identify discriminative features for classification, were 75%/18% and 100%/6%, respectively. The results demonstrate that combinations of selected ERP time segments across different electrodes contain signal features that discriminate AD from control subjects with high sensitivity and specificity.

Theta-power differences in patients with mild cognitive impairment under rest condition and during haptic tasks

The aim of this study was to investigate spectral EEG theta-power during perceptive-cognitive demands in age-homogeneous groups of subjects with mild cognitive impairment (MCI), mild dementia (MDE), and a healthy control (CO) group. The present study includes 51 subjects (23 males, 28 females). We used the scales of the CDR (clinical dementia rating) to assign the subjects to the different groups. EEG data were collected during 10 minutes rest condition with eyes closed and during haptic perception test. The quality of the haptic reproductions differed significantly between CO and MCI, as well as between CO and MDE. The statistical comparison between EEG theta-power under rest condition and theta-power during haptic tasks revealed a significant decrease in theta-power during haptic tasks in all three groups over parieto-occipital regions. During haptic tasks, the theta-power was significantly different between CO and MDE over occipital regions and over parieto-temporal regions. A significant difference between CO and MCI was only revealed over right occipital regions (O2). Spectral theta-power during haptic tasks is a suitable measure to distinguish healthy subjects (CO) from patients with MCI respectively MDE. The results show that haptic tasks are sensitive to early perceptive-cognitive and functional deficits in patients with MCI.

EEG abnormalities in dementia reflect the parietal lobe syndrome

The aim of this study was to investigate to what extent the examination of regional syndromes can improve EEG diagnostics in dementia. The study was based on 77 patients, aged between 47 and 83 years, with a dementia disease in accordance with the DSM-III-R criteria. The clinical examination was refined using a so-called stepwise clinical status analysis to estimate the occurrence and intensity of the parietal lobe syndrome, the frontal lobe syndrome, the subcortical syndrome and the less-regionalised global syndrome. In the same time period, the patients were examined electroencephalographically and the recordings were assessed both visually and by means of spectrum analysis. It was found that the intensity of the parietal lobe syndrome was correlated more strongly to the EEG slow activity as compared to the other regional syndromes. Thus, it can be expected that the EEG will be most valuable in the early-onset type of Alzheimer's disease, in which the parietal syndrome is dominant, giving information regarding the degree of dementia and suggesting a possible interference with depression. The results of the study can probably explain some discrepancies between the EEG findings and the results of clinical examination in other forms of dementia.